CONSEQUENCES OF HYPOPITUITARISM FOLLOWING TRAUMATIC BRAIN INJURY (TBI)

创伤性脑损伤 (TBI) 后垂体机能减退的后果

• 批准号: 7717891
• 负责人: LAURENCE KATZNELSON
• 金额: $ 0.17万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-12-01 至 2008-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7717891
• 关键词: 6 year old; Activities of Daily Living; Adrenal gland hypofunction; Affect; Androgens; Anorexia; Anterior Pituitary Gland; Behavioral; Body Composition; Body Weight decreased; Body fat; Bone Density; Cardiovascular system; Chronic; Chronic Phase; Clinical; Cognitive; Computer Retrieval of Information on Scientific Projects Database; Deterioration; Economics; Estrogens; Exercise Tolerance; Fatigue; Fatty acid glycerol esters; Female; Functional disorder; Funding; Glucocorticoids; Goals; Gonadal Steroid Hormones; Grant; Hormones; Hypogonadism; Hypopituitarism; Hypothyroidism; Impaired cognition; Injury; Institution; Lassitude; Lead; Literature; Malaise; Memory; Memory Loss; Mental Depression; Musculoskeletal System; Myopathy; Neurologic; Organic brain syndrome; Outcome; Patients; Performance; Pilot Projects; Pituitary Gland; Production; Prolactin; Protocols documentation; Psychotic Disorders; Quality of life; Recording of previous events; Recovery; Rehabilitation therapy; Relative (related person); Replacement Therapy; Research; Research Personnel; Resources; Signs and Symptoms; Skeletal Muscle; Somatotropin; Source; Syndrome; TBI Patients; Testing; Testosterone; Thyroid Gland; Traumatic Brain Injury; Unemployment; United States National Institutes of Health; Weight Gain; Woman; design; disability; disturbance in affect; falls; growth hormone deficiency; men; neuropsychiatry; respiratory

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Hypotheses: This protocol will investigate the effect of traumatic brain injury (TBI)-associated hypopituitarism on body composition, quality of life (QOL), and activities of daily living (ADL). We hypothesize that: 1. TBI is associated with a high degree of hypopituitarism, including growth hormone deficiency. 2. Hypopituitarism in patients with TBI is associated with diminished skeletal muscle mass and increased body fat, decreased QOL, and decreased ability to perform ADL compared to patients with normal pituitary function. 3. In patients with history of TBI, the degree of hypopituitarism correlates with the degree of deterioration in skeletal muscle mass, body fat, QOL, and ADL. Goals: TBI has profound clinical and economic consequences. Common sequelae of injury include neurologic or neuromuscular damage, cognitive dysfunction, physical deconditioning, weight gain, or fat redistribution, as well as diminished quality of life and overall performance. These sequelae have been identified as major obstacles to successful rehabilitation. Many TBI patients fall short of complete recovery altogether and enter into a phase of chronic disability and unemployment. The syndrome of hypopituitarism is widely recognized, and the importance of replacement therapy well understood. Dysfunction of the anterior pituitary gland may lead to a compromise in growth hormone (GH), thyroid, glucocorticoid, sex hormone (testosterone in men/estrogen in women), and prolactin production. In general, patients with hypopituitarism present with fatigue and either weight gain or loss, and may have one or more hormone axes compromised. Central hypothyroidism widely impacts the respiratory, cardiovascular, neurologic, and musculoskeletal systems and therefore is associated with fatigue, poor exercise tolerance, impaired memory, and cause weakness and myopathy. Hypogonadism (testosterone deficiency) in men can lead to adverse affects on body composition, bone density, and neuropsychosocial function. Testosterone deficiency in men can have behavioral and cognitive consequences including mood disturbances, decreased verbal fluency, impaired memory, and poor QOL. There is a growing literature on the relative androgen deficiency in female patients with central hypogonadism, which may have adverse consequences on lean mass and function. Signs and symptoms of chronic adrenal insufficiency include malaise, lassitude, weakness, anorexia, and weight loss. In severe and chronic cases, patients may have neuropsychiatric manifestations such as memory loss, organic brain syndrome, depression, and overt psychosis. This pilot study will consist of a cross-sectional design with men and women between 18-55 years old 6 months following TBI. Control subjects will be identified posthoc by normal pituitary function. We will test body composition, QOL, and ADL in each subject to compare differences in hypopituitary vs. normal subjects and also correlate degree of hypopituitarism to degree of differences in outcomes.

该子项目是利用该技术的众多研究子项目之一 资源由 NIH/NCRR 资助的中心拨款提供。子项目和 研究者 (PI) 可能已从 NIH 的另一个来源获得主要资金， 因此可以在其他 CRISP 条目中表示。列出的机构是 对于中心来说，它不一定是研究者的机构。 假设： 该方案将调查创伤性脑损伤 (TBI) 相关垂体功能减退症对身体成分、生活质量 (QOL) 和日常生活活动 (ADL) 的影响。我们假设： 1. TBI与高度垂体功能减退有关，包括生长激素缺乏。 2. 与垂体功能正常的患者相比，TBI 患者的垂体功能减退与骨骼肌质量减少、体脂增加、生活质量下降以及日常生活能力下降有关。 3.有TBI病史的患者，垂体功能低下的程度与骨骼肌质量、体脂、QOL和ADL的恶化程度相关。 目标： TBI 具有深远的临床和经济后果。损伤的常见后遗症包括神经或神经肌肉损伤、认知功能障碍、身体不适、体重增加或脂肪重新分布，以及生活质量和整体表现下降。这些后遗症已被确定为成功康复的主要障碍。许多 TBI 患者未能完全康复，并进入慢性残疾和失业阶段。 垂体机能减退综合征已得到广泛认可，替代疗法的重要性也广为人知。垂体前叶功能障碍可能会导致生长激素 (GH)、甲状腺、糖皮质激素、性激素（男性睾酮/女性雌激素）和催乳素产生受损。一般来说，垂体功能减退症患者会出现疲劳、体重增加或减轻，并且可能有一种或多种激素轴受损。中枢性甲状腺功能减退症广泛影响呼吸、心血管、神经和肌肉骨骼系统，因此与疲劳、运动耐量差、记忆力受损有关，并导致虚弱和肌病。男性性腺功能减退症（睾酮缺乏）会对身体成分、骨密度和神经心理社会功能产生不利影响。男性睾酮缺乏会产生行为和认知后果，包括情绪障碍、言语流畅性下降、记忆力受损和生活质量差。关于中枢性性腺功能减退症女性患者相对雄激素缺乏的文献越来越多，这可能对瘦体重和功能产生不利影响。慢性肾上腺功能不全的体征和症状包括不适、疲倦、虚弱、厌食和体重减轻。在严重和慢性病例中，患者可能出现神经精神表现，如记忆丧失、器质性脑综合征、抑郁症和明显的精神病。 这项试点研究将包括 TBI 后 6 个月内 18-55 岁男性和女性的横断面设计。对照受试者将通过正常的垂体功能进行事后鉴定。我们将测试每个受试者的身体成分、生活质量和日常生活能力，以比较垂体功能低下与正常受试者的差异，并将垂体功能低下的程度与结果差异程度相关联。